Analyses of ambulatory care-sensitive conditions

It is possible to avoid unnecessary hospital admissions for patients with some conditions by giving them good quality preventive and primary care – their illnesses are known as ambulatory care-sensitive conditions. This project looked at the impact of these conditions on hospital admission rates and what this tells us about changes in the quality of care.

As well as out-patient treatment, ambulatory care also includes preventive measures such as screening and helping the patient to manage factors which put them at risk of an avoidable hospital admission, such as cholesterol and blood pressure.

Rates of admissions for ambulatory care-sensitive (ACS) conditions are often used as a measure of the quality of primary care in a local area, and some appear in the NHS outcomes framework. While the techniques are often used to explore the variation between areas, our analysis has also looked at changes in the levels of these admissions over a period of ten years for all of England.

We examined approximately 46 million hospital records to see if rates had fallen – and if so for which groups of conditions. The results were published in a BMJ Open paper that describes the national trends over ten years.

This project looked at the impact of preventive care for patients at risk of avoidable emergency admissions and whether new policies really do help them

This analysis showed that for some conditions we can see improvements – for example reductions in emergency admissions from angina or peptic ulcer. Such changes are linked to improvements in treatment and changes in population health status.

However, the successes were relatively small in scale compared to the overall increases in ACS admissions over the past decade. It appears that emergency admission for these conditions have increased more or less in line with the rise in total emergency admissions, suggesting that our efforts to reduce emergency admissions have in general not been successful. The increases are greatest in relatively non-specific diagnoses and are associated with older people.

This analysis was subsequently taken forward as part of QualityWatch, a joint research programme by the Nuffield Trust and Health Foundation providing independent scrutiny into how the quality of health and social care is changing over time.

In addition to the national trends, we looked in detail at the patterns of changes in ACS admission across the country. We were particularly interested in what these patterns could tell us about the overall quality of preventive care. The links between measures of deprivation and ACS admission, and the extent to which it can help explain some of the variation seen across England, were also examined.

These findings were published in October 2013 – visit the QualityWatch website to download the report and access additional resources. This work is likely to be of interest to policy-makers, health service managers, commissioners and the wider health service.

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The Nuffield Trust is an independent health charity. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.